Granuloma Faciale: An Ultrastructural Study

Ortega, Vicente Vicente; Sánchez‐Pedreño, Paloma; J, Vicente

doi:10.3109/01913129809032268

Cited by 10 publications

(3 citation statements)

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“…[1][2][3] The aetiopathogenesis of this condition is not clear, and several hypotheses including cutaneous vasculitis have been proposed. 4 A histological hallmark of the disease is the infiltration of numerous eosinophilic granulocytes together with macrophages and lymphocytes in a typical granulomatous pattern. 5 We have analysed the cellular infiltrate and cytokine production in two patients presenting with granuloma faciale (eosinophilicum).…”

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High local interleukin 5 production in granuloma faciale (eosinophilicum): role of clonally expanded skin-specific CD4+ cells

Gauger¹,

Ronet

Schnopp³

et al. 2005

Br J Dermatol

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that GPs find it difficult to recognize skin cancer and prioritize referrals. Limited urgent capacity is filled with routine referrals at the expense of delaying detection of skin cancer from nonurgent referrals. Dermatologists must therefore pay particular attention to nonurgent referrals to ensure that these referrals are assigned equal priority.In summary, skin cancers are referred urgently and nonurgently by GPs. The urgency assigned to the referral influences the waiting time. Administrative streamlining helps to meet the 2-week target for urgent referrals but further resources are needed so that nonurgent referrals can be seen more quickly. SIR, Granuloma faciale (eosinophilicum) is a rare granulomatous inflammation of the skin usually presenting as infiltrated multiloculated reddish nodes of the face, although there have been several reports of similar lesions in extrafacial localizations. 1-3 The aetiopathogenesis of this condition is not clear, and several hypotheses including cutaneous vasculitis have been proposed. 4 A histological hallmark of the disease is the infiltration of numerous eosinophilic granulocytes together with macrophages and lymphocytes in a typical granulomatous pattern. 5 We have analysed the cellular infiltrate and cytokine production in two patients presenting with granuloma faciale (eosinophilicum).Patient 1 was a 44-year-old white man who described slowly progressive dark red papules and plaques arising at the cheeks and ear lobes for at least 10 years (Fig. 1A). He had undergone several treatments including local steroid injections, cryosurgery and dapsone before being transferred to our department. After informed consent was obtained, a biopsy was taken from an untreated newly developing lesion at his left ear lobe.Patient 2 was a 67-year-old white woman who presented with a 5-year history of continuously growing firm red plaques at both cheeks and the forehead. The skin lesions were painless and had inconstantly increased in size. At initial presentation we saw multiple painless red nodules of 1-2 cm diameter with a tender consistency located at the forehead and both cheeks (Fig. 1E). After informed consent was obtained, two biopsies were taken from different skin lesions and were split for (immuno)histology and molecular biology.Routine haematoxylin and eosin staining in both patients showed subcutaneous granuloma formation with multinucleated giant cells surrounded by lymphocytes and a prominent infiltration of granulocytes among which eosinophils clearly dominated (Fig. 1B,F). The histological picture and the clinical appearance were consistent with facial granuloma.Immunohistochemistry showed a dominant recruitment of CD4+ T cells among the infiltrating lymphocytes (Fig. 1C,G) and only a weak staining for CD8 (data not shown), a result which confirmed previous investigations 6 (all antibodies from Dako, Hamburg, Germany).We next searched for an explanation for the parallel infiltration of CD4+ T cells and the infiltration of numerous eosinophils into the skin. A major cyto...

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“…1 A vulval location of this disease is exceptional, but has been reported subsequent to Stevens-Johnson syndrome (SJS) or CO 2 laser treatment. [2][3][4][5][6] We describe the first case of vaginal adenosis occurring 3 years after toxic epidermal necrolysis (TEN).…”

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High local interleukin 5 production in granuloma faciale (eosinophilicum): role of clonally expanded skin-specific CD4+ cells

Gauger¹,

Ronet

Schnopp³

et al. 2005

Br J Dermatol

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“…It has a typical histopathologic appearance consisting of an eosinophil‐rich, mixed dermal infiltrate which is separated from the epidermis and skin appendages by a thin band of uninvolved dermis and is most pronounced in perivascular areas 1–3 . Although granuloma faciale is classically considering one of the two chronic fibrosing vasculitides, along with erythema elevatum diutinum, reported vascular involvement in granuloma faciale has ranged from true vasculitis, to concentric hyalinization, to capillary dilation, to wall infiltration by inflammatory cells, to capillary proliferation, to no involvement 1,2,4–9 . Immunofluorescence findings have rarely been reported, but have included granular IgG, IgA, IgM, and C3 in the dermoepidermal junction, in blood vessel walls, and along connective tissue fibers; linear IgG only along the basement membrane zone; and IgG around blood vessels only 9–11 …”

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Immunofluorescence findings in granuloma faciale: report of two cases

et al. 2003

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Immunofluorescence findings were essentially identical to those which would be expected in cutaneous LE; however, the combination of negative serologic studies for LE, histopathologic findings typical of granuloma faciale, and clinical findings most consistent with granuloma faciale allowed the diagnosis of granuloma faciale to be rendered with certainty. Interpretation of results of direct immunofluorescence of skin should be correlated with clinical presentation, histopathological findings and other laboratory results in order to render final diagnosis of a given patient.

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